*1Ukam, I. I., 1Iyam, S. O., 1Ugbadu, J. I., 2Unoh, F. B., 1Ukeye, A. A., 1Okoro B. C., 1Akpeke, V. U., and 3Umoh, N. O.
1Department of Microbiology, Faculty of Biological Sciences, University of Calabar, PMB 1115 Calabar, Nigeria
2Department of Science Laboratory Technology, Faculty of Biological Sciences, University of Calabar, PMB 1115 Calabar, Nigeria
3Department of Bacteriology, Virology and Mycology, Faculty of Medical Laboratory Science, University of Calabar, PMB 1115, Calabar, Nigeria
*Correspondence to: ukamjohn8@gmail.com & igborukam@unical.edu.ng; Mobile: +2349074254995/ +2348032327041; ORCiD ID: 0009-0005-7645-5508
Abstract:
Background: The global spread of the extended spectrum beta-lactamases (ESβL) and carbapenemases producing strains of Klebsiella pneumoniae constitutes a public health threat to both humans and animals. This study investigated the prevalence of ESβLs genes among multidrug resistant (MDR) K. pneumoniae isolates from clinical specimens of patients attending selected hospitals in Calabar, Nigeria.
Methodology: This was a laboratory-based study of 80 K. pneumoniae isolates preliminarily identified at the routine microbiology laboratories of four healthcare facilities in Calabar metropolis, with 60 K pneumoniae isolates confirmed using VitekR 2 Compact system (BioMérieux; Marcy L’Étoile, France). Antibiotic susceptibility testing of the confirmed isolates to selected antibiotics was performed by the Kirby Bauer disc diffusion method and result interpreted using the Clinical and Laboratory Standards Institute (CLSI) guidelines. MDR was defined as resistance to three or more antibiotic classes. ESBL (blaCTM-M and blaKPC) genes were detected among the MDR strains by conventional PCR assay and agarose gel electrophoresis of the gene amplicons. Data of patients from whom the organism were recovered, were extracted from the laboratory records. Pearson’s Chi square test was used to measure association between categorical variables, and p ≤ 0.05 was considered statistically significant.
Results: Of the 60 confirmed K. pneumoniae isolates, the highest frequency of the isolate recovery was from patients aged >60 years (25.0%, n=15) and 50-60 years (21.7%, n=13), while the least frequency was from patients aged 1-10 years (5.0%, n=3). Recovery rate was higher in females (n=35, 58.3%) compared to males (n=25, 41.7%). The frequency of resistance of the isolates to meropenem, piperacillin/tazobactam, amoxicillin/clavulanate, ciprofloxacin, gentamicin and ceftriaxone was 25.0% (n=15), 31.7% (n=19), 36.7% (n=22), 48.3% (n=29), 48.3% (n=29) and 76.7% (n=46) respectively. Only 15 (25.0%) of the 60 isolates were
MDR strains. Age was significantly associated with MDR strains, with higher frequency in age groups 51-60 years (38.5%, n=5/13) and >60 years (40.0%, n=6/15) compared to other age groups (x2=13.733, p=0.035). Carriage rate of blaCTX-M gene among the MDR strains was 100% (n=15) while only 26.7% (n=4) carried the blaKPC genes.
Conclusion: The relatively high prevalence of ESβLs encoding genes among K. pneumoniae clinical isolates in this study may represent a grim prospect for successful treatment and management of infections caused by this pathogen in the population. Informed and discrete use of antimicrobial drugs, particularly β-lactam antibiotics, for management of bacterial infections will prevent further escalation of drug-resistance in this epidemiological setting.
Keywords: Prevalence, Klebsiella pneumoniae, Multidrug resistance, ESBL, blaCTX-M, blaKPC
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